Outbreak surveillance Central Surveillance Unit IDSP Early Warning

Outbreak surveillance Central Surveillance Unit, IDSP

Early Warning Signal (EWS) reports • All SSUs are required to send EWS reports (disease alerts/outbreaks) to CSU on time every week for sharing with the stakeholders • Even ‘Nil’ reporting is mandatory • An average of 20 States/UTs are reporting every week

Total no. of outbreaks reported through IDSP by the States/UTs in 2008 -2011 (till 26 th June 2011) Year All 35 States/UTs 9 WB funded States/UTs 2008 553 400 (72%) 2009 799 488 (61%) 2010 990 619 (63%) 2011 699 516 (74%) (till 26 th June )

Weekly EWS / Outbreak report submitting Status of States/UTs in 2011 (till 25 th week ending on 26 th June) EWS/OUTBREAK REPORT SUBMITTING STATUS STATES / UTs > 80% times reported (Consistently and timely reporting) Andhra Pradesh, Arunachal Pradesh, Assam, Bihar, Jammu & Kashmir, Karnataka, Kerala, Madhya Pradesh, Manipur, Meghalaya, Orissa, Punjab, Rajasthan, Tamil Nadu, Tripura, Uttarakhand, West Bengal 50 - 79 % times reported Chandigarh, Daman & Diu, Goa, Gujarat, Himachal Pradesh, Maharashtra, Puducherry, Sikkim, Uttar Pradesh 25 - 49 % times reported Chhattisgarh, Delhi, Haryana, Nagaland < 25 % times reported Lakshadweep, Mizoram, Jharkhand Never reported Andaman & Nicobar, Dadra & Nagar Haveli

State-wise total no. of outbreaks reported through IDSP by all States/UTs in 2008, 2009, 2010 & 2011 (till 25 th wk ending June 26 th 2011)

State-wise total no. of outbreaks reported through IDSP by the World Bank funded States in 2008, 2009, 2010 & 2011 (till 25 th wk ending June 26 th 2011) Sl. No. State Year Total 2008 2009 2010 1 Andhra Pradesh 72 64 75 2 Gujarat 24 49 83 3 Karnataka 54 97 90 4 Maharashtra 99 27 65 5 Punjab 17 22 18 6 Rajasthan 8 43 84 7 Tamil Nadu 50 113 90 8 Uttarakhand 27 30 25 9 West Bengal 49 43 89 400 488 619 Sub Total 2011 39 101 110 32 24 50 49 21 90 516 250 257 351 223 81 185 302 103 271 2023

State-wise total no. of outbreaks reported through IDSP by the non-WB funded States in 2008, 2009, 2010 & 2011 (till 25 th wk ending June 26 th 2011)

Disease-wise total no. of outbreaks reported through IDSP by all States in 2008, 2009, 2010 & 2011 (till 25 th wk ending June 26 th)

No. of disease outbreaks for which Laboratory facilities accessed and etiology confirmed by the States/UTs through IDSP in 2008, 2009, 2010 and 2011 (till 26 th June 2011)

Monitoring quality of outbreak investigations

Competency Assessment Tool for Outbreak Investigations Sl. No. TOOL INDICATORS 1 Is it an outbreak? (Verification of rumor / media alert done or not) Was the outbreak informed/ identified by weekly data analysis? 2 Timeliness of Response by Rapid Response Team Period between date of start of outbreak and date of response (first reported to a health worker at any health facility) Composition of outbreak response team 3 Laboratory confirmation of outbreak Type of clinical specimen Transport media Results 4 Case definition What working case definition was used? 5 Active case finding Was active house to house case search done? What population was covered? Line listing to compile cases from health facility records and active case search 6 Description of cases in time, place and person Use of epicurve, spot map, graphs? 7 Conclusion Is source of the outbreak determined? Is mode of transmission established? 8 Specific public health intervention measures undertaken Case management Control measures Outcome (CFR) 9 Recommendations What recommendations were proposed? Were they implemented? 10 Feedback given or not Written feedback Post- outbreak review

Quality Assessment of Outbreaks reported by all States in 2011 (till 26 June) using 3 Essential Criteria Essential criteria Investigation within 48 hours of first case information Adequate samples sent for lab investigation within 4 days Availability of final outbreak report % of response to disease specific outbreaks (n=699) • 510 (73%) • In 302 (43%) outbreaks, appropriate human samples sent for lab investigation • 88 (13%) outbreaks etiologically confirmed • 5%

Quality Assessment of Outbreaks reported by 9 WB funded States in 2011 (till 26 June) using 3 Essential Criteria Essential criteria Investigation within 48 hours of first case information Adequate samples sent for lab investigation within 4 days Availability of final outbreak report % of response to disease specific outbreaks (n= 516) • 385 (75 %) • In 242 (47 %) outbreaks, appropriate human samples sent for lab investigation • 66 (13 %) outbreaks etiologically confirmed • 4%

Improving Outbreak detection and reporting 1. Early detection and response to outbreaks by identifying EWS from routine analysis of surveillance (S, P, L) data at DSU/CHC/PHC levels (by identifying any unusual rise in no. of cases) 2. Ensure 100% reporting of EWS/outbreaks by all States/Districts (even “NIL” reporting is mandated) • • • every week on time in the prescribed format 3. Avoid incomplete/incorrect data entry in the EWS format – Date of start & reporting of outbreak to be mentioned for all outbreaks – “Population affected” is the “Population at risk”

Improving the quality of outbreak investigations, reporting and response 1. 2. 3. 4. Lab confirmation of diagnosis needs appropriate clinical (human) samples to be sent for lab tests Identification and Training of Epidemiologists, Microbiologists, Entomologists and RRT members at DSU / SSU levels Existence of a written case management protocol for any epidemic should be made available by the State at each PHC/CHC/District level Competency assessment tool to be utilized for improving the quality of outbreak investigations and reporting (by the Epidemiologists and Surveillance Officers)

Thank you idsp. outbreakcell@gmail. com